An ostomy is a surgically created opening, called a stoma, on the abdomen that allows stool or urine to exit the body when the natural pathway is impaired or removed. Because the stoma has no muscle to control output, an external appliance or pouching system is worn to collect the waste. Regularly and safely changing this appliance is fundamental to maintaining the integrity of the skin surrounding the stoma, known as the peristomal skin, and preventing leakage.
Essential Supplies and Preparation
Preparation is the first step toward a successful appliance change, ensuring the procedure is quick and clean. Essential supplies include:
- A new pouching system (one- or two-piece) and skin barrier or wafer
- A measuring guide and specialized scissors
- Accessory items like barrier rings, stoma paste, or powder
- Cleaning materials such as adhesive remover wipes, soft gauze, and warm water
A disposal bag and a clean towel should also be set out to manage waste and protect surfaces. The optimal time to perform a change is typically when the stoma is least active, often first thing in the morning or two to three hours after a meal. Having all materials laid out minimizes interruptions and the risk of accidental contact with output.
Safe Removal and Stoma Assessment
The removal of the old appliance must be done gently to protect the peristomal skin from stripping or tearing. Use one hand to support the skin near the edge of the barrier while the other hand slowly peels the adhesive away, pulling it toward the stoma. Adhesive remover wipes or spray can be used to dissolve stubborn residue.
Once the old system is discarded, the stoma and surrounding skin must be cleaned with warm water and a soft cloth. Avoid soaps containing oils, fragrances, or alcohol, as these interfere with adhesion. Cleansing should be gentle; minor pinprick bleeding from the stoma is normal due to its rich blood supply. The peristomal skin must be patted completely dry, as a wet surface prevents the new adhesive from securing properly.
Next, carefully assess the stoma and surrounding skin. A healthy stoma should appear moist, pink, or reddish, similar to the inside of the mouth. The peristomal skin should be intact, smooth, and match the color of the abdomen, without rashes or broken areas. Any significant changes, such as a pale, blue, or dark color, blistering, or persistent redness, should be reported to a medical professional.
Detailed Steps for New Appliance Application
Before applying the new system, the stoma must be measured, especially in the months following surgery, as its size and shape can change. A measuring guide is used to find the size that fits most closely around the stoma without touching it. For a cut-to-fit barrier, the hole is traced onto the back of the wafer and cut with specialized scissors. Ensure the opening is snug—about one-eighth of an inch (2mm) larger than the stoma itself.
If the skin is uneven or irritated, accessory products are applied next. Lightly dust skin barrier powder onto any weepy or broken skin, brushing away the excess before applying a skin sealant or barrier film. Barrier rings or paste are then used to fill gaps or crevices between the stoma and the skin, creating a level surface and a tighter seal.
Apply the new barrier after removing its protective backing, centering it carefully over the stoma. Apply gentle, firm pressure across the entire adhesive surface to smooth out wrinkles and secure the seal. Hold the palm of the hand over the barrier for one to two minutes, as body heat activates the adhesive and molds the wafer to the skin contours. If using a two-piece system, the pouch is then snapped or locked onto the barrier, and the bottom of a drainable pouch is secured.
Troubleshooting Common Issues and When to Seek Help
A secure seal should feel comfortable after the change. Minor bleeding or skin irritation may occur, but small spots of blood on the stoma during cleaning are usually minor and resolve quickly. Bleeding from within the stoma lumen, however, requires medical attention. Persistent itching, burning, or a painful rash suggests output is compromising the seal and irritating the skin, requiring immediate attention and possibly a change in barrier type.
Leakage is the most common issue, often resulting from an improperly sized barrier opening or inadequate skin preparation. If the appliance consistently leaks before the expected wear time of three to seven days, re-evaluate the fit and use barrier rings or paste to reinforce the seal. Pancaking, where stool collects at the top of the pouch, can also lift the barrier and cause leaks, sometimes requiring a lubricant or air to prevent the issue.
Specific signs warrant contacting a Wound, Ostomy, and Continence (WOC) nurse or a physician immediately:
- Severe skin breakdown or open wounds
- A stoma that changes color to a dark, purple, or black shade
- Any significant, sudden change in the stoma’s size or shape
- Consistent, unmanageable leakage
- Fever or severe abdominal pain
Professional guidance is needed to prevent serious complications.